August 20th, 2008

HPV vaccines, redux

The NYT has a five page article here:

You know me: I don't trust doctors, I don't trust vaccines, I think a lot of this stuff has risk that doesn't make it worth the benefits and I think even more of it is too expensive to justify, considering all the other worthwhile things we could be spending the money on (like, say, more BPA and/or pthalate laden plastic toys for deprived children. Wait. Never mind).


Duration of protection is in question (has been all along, apparently) so three years or so out a booster shot might be needed. Ask yourself: why the heck would you vaccinate a 12 year old girl against a disease she'll only get by having sex when you may well have to have it boostered several times before she hits college where it's really going to count?

There's been huge compliance with this thing. The article develops in some detail the financial conflicts of interest involved in efforts to mandate compliance. Because so many girls have gotten this vaccine, we're seeing a lot of reports of adverse effects including 20 deaths. Yes, Virginia, we _get_ that some if not all of those 20 deaths may be a straight up case of post hoc ergo propter hoc and nothing to do with getting the shot(s). Nevertheless, a pretty strong argument to delay if possible.

But most amazingly, the article takes seriously the cost/benefit issue in terms of what we _aren't_ doing because we're spending a billion or so on this puppy. Given that at best, it protects against 70% of the HPV out there when the studies were conducted, and therefore you'll _still_ have to get regular pap smears, you have to ask yourself: how much would _you_ pay, or ask your taxing authority to pay, to reduce the fears associated with an abnormal pap smear for 1 in some large number of women? Because the odds of saving _anyone_ with this thing are slim.

quitting and decision making

A while ago, I reviewed (more or less favorably, IIRC), Seth Godin's _The Dip_, a thin book about when not to pursue a goal.

In this Olympic season, it was perhaps inevitable that someone would muse about "quitters never win and winners never quit", Godin's book, and a variety of other research that shows that, in fact, winners _do_ quit (often, at times) and then try to draw some conclusions about, say, parenting.



After telling a story about a couple of idiots bidding up to $204 for a $20 bill (auction structure: winner gets the bill, but the 2nd high bidder has to pay up their bid, too, only they get nothing), and observing: "This tendency to feel so invested in a situation — or too embarrassed to admit that we might have chosen the wrong path — permeates all aspects of our lives", the author nevertheless still feels that it is hard, as a parent, to allow a child to quit.

My parents had this attitude about a variety of things. Music lessons on the accordion (even _after_ accordions became cool, I still loathe them, and I was actually really compliant about practicing and eventually switched to piano. To this day, I can't bring myself to touch a musical instrument with any serious intent, largely as a result of this parenting style). Our religion (yes, well, we all know how _that_ turned out). They didn't, as a general rule, permit us to _have_ after-school activities, so there wasn't much there to quit. However, they insisted that we quit those activities our religion decided, after we had started them, were inappropriate in some way.

Way to go, 'rents.

Needless to say, I have some strong opinions on this subject, that can be summarized as: You want to try this? How bad? Okay. You don't want to do this any more? How bad? Okay. If money is/was/were to become an issue, I'd just lay it out for them: here's what we got. How do _you_ want to spend it. Poll the family. Come to consensus (by exhaustion if necessary).

The author goes on to (accurately) describe the internal state of many parents: "The urge is often to tell him to stick with it because he’ll appreciate it when he’s older, or he made a commitment (and we spent the money), or because we fear that letting him give up this time means he will give up on anything when it gets a little tough."

Right. Because people _generally speaking_ give up the things they truly love and care about when things get a little tough.


Oh, and btw, good way to teach kids how to engage in the classic error of sunk costs. Not to mention destroying the intrinsic motivational structures that will ensure your kids grow up to be adults with some stamina when it comes to pursuing the difficult-but-valued.

Fine. Whatever. I'd really be able to live with all this. The author is just working through the emotional tangle and _I respect that_. I really do. This, not so much:

"Rom Brafman, who is also a psychologist [sez on the subject of the _right_ way to quit which the author and Brafman assert is important]: “It is as important to teach someone how to quit as staying committed,” he said. “Lots of times people just stop showing up, and that’s wrong.” Rather, he suggested, say something like “ ‘I tried to work it out, and this not a good match for me.’ Do it in a responsible manner.”

I've quit by not showing up. I've quit by volunteering why I'm quitting. I've quit by responding to in-person or in-writing surveys of why-d'ya'quit. I've quit involving the courts (divorce). I've quit involving a multi-page, single spaced explanation of _why I quit_ in front of a bunch of JW elders, bringing someone with me as a witness.

And I have so say, there's a _helluva_ lot to be said for not showing up. If you just stop showing up, and people come after you, you have a reasonable chance at getting a restraining order against _them_. If you quit and insist on explaining yourself, there's a chance they'll get one against you. People who show up with guns in workplaces after they've been discharged are quitting with an (emotional and highly inappropriate) explanation.

Right way to quit my ass. We may live in a society that worships contracts. Don't you be suckered. If there _is_ a contractual obligation, think about the consequences of breaking it. But if it's one of those "social contract" or so-help-me "etiquette" things? Quitting without an explanation is a _really phenemonally good_ way to quit. Saves face all 'round.

The author concludes with the expectable -- but still so moronic as to be evil -- conclusion from Godin that the worse time to quit is "when you’re feeling the most pain". Godin does a nice job of this in the book that is inadequately summarized in this article of explaining how to avoid quitting while you are in the most pain, and for the most part, it amounts to noticing that this is _going_ to be painful, and quitting before the pain starts so as to avoid the temptation to quit in the middle (pain with no payoff) or stick it out when it isn't really worth it to you (sunk costs). And in this context, I will refer you to the Groningen protocol. The Hastings Center (free registration) had a great article defending it (at least in the Dutch context) a while ago, and it may be the single strongest temptation I've ever encountered for transplanting myself once again, to the home of (most of) my ancestors. These people know how to think through a tough problem, and make the right decision -- and how to explain how to do it to other people so it can be done in an Orderly Fashion. Because, after all, that is the Dutch way.

Don't research that if you are already depressed; it won't cheer you up at all. I'm serious when I say this is some of the best decision making I've ever encountered in my life. But the subject matter is hard, and some of the secondary commentary is obscene in both how it misrepresents the protocol, and the value systems represented by that commentary.

decision-making and the GSEs

This is the article that probably caused the GSEs to drop a bit further, and spawned a bunch of secondary commentary. It's a three-pager.

Here's what I would like someone to explain to me (Floyd Norris at the NYT has recently tackled the difficult issue of the business cycle viz. what's right for individuals often goat-fucks the group further, altho Mr. Norris, of course, would never, ever, ever use such language). If we're all so convinced (and that seems to be the punditry Trend Du Jour) that the GSEs are going to need to use that bailout provision and shareholders really are going to completely lose everything, why did Fannie show good judgment/get lucky by raising a round of new equity capital in May, while Freddie (on legal advice and in some articles, in compliance with their regulator's advice, but in this article to the Shock, Shock! of the Bush administration -- statements which may actually not be incompatible, which tells you a lot about where we are right now from a governance perspective) screwed the pooch by delaying then (when the stock was down from 67 to 25) and now (when it's down in the single digits).

Essentially, anyone who bought Fannie back in May is going to lost that shirt -- and probably sign up (or vote based on promises of) for whatever recompense might become available somehow, somewhen, whereas by _not_ raising capital that I think we all know is hopelessly inadequate to the disaster that is the real estate market right now, Freddie avoided pissing off some number of people who might have bought in back then.

I mean, this is like two people whose houses got foreclosed and sold. Person A gutted their retirement and borrowed every last nickel friends and family would loan them etc. and still lost the overpriced house on a bad loan in a terrible location. Person B kept a cash cushion, left their IRA and 401(k) intact and _maybe_ borrowed from friends and family for first last and security on a rental after mailing the keys to the lender.

And yet we are somehow after Person B, who is sensible and took the long view and will not be a burden on anyone else (subject to whatever future disaster overtakes them) and very sympathetic to Person A, who we are going to be funding, one way or another, for the foreseeable future. And possibly incarcerating their totally fucked up offspring. And so on. Unless, of course, we deport them (which seems to be the solution of the day.

I just don't get it. As near as I can tell, we've been making really bad decisions collectively for pretty much my whole life (while Carter cut a bunch of wasteful defense projects, they all got reinstated, so it's not clear that counts one way or the other). I don't see that changing. What I do see, is that every once in a while, someone decides _not_ to do the stop gap stupid thing to get through the day that isn't going to really help at all. And _those_ people, my god, they are THE DEVIL and WE MUST GET THEM.

Because otherwise, they might make the rest of us look like the fools that we are.